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TUESDAY, Dec. 19, 2017 (HealthDay News) — The U.S. Food and Drug Administration on Tuesday called for tougher warnings and “additional research” into a dye commonly used with standard MRIs.
The dye — a “contrast agent” — contains a metal called gadolinium. It made news recently after claims from actor Chuck Norris that its use during MRI scans seriously affected his wife’s brain.
Contrast agents are injected into the body during an MRI scan to enhance image quality.
In November, Norris and his wife, Gena, filed a lawsuit against several medical companies alleging she fell ill after exposure to gadolinium during MRI scans.
The suit said Gena Norris was left weak, tired and suffering bouts of pain and burning sensations.
After reviewing available data, the FDA on Tuesday recommended that radiologists consider how much gadolinium might be left behind in a patient’s body when selecting a gadolinium-based contrast agent [GBCA] for an MRI.
The recommendation is especially important “for patients who may be at higher risk, such as those who may require repeat GBCA MRI scans to monitor a chronic condition,” explained Dr. Janet Woodcock, director of the agency’s Center for Drug Evaluation and Research.
Patients who are sent for an MRI should also now receive a medication guide outlining issues surrounding gadolinium, Woodcock added.
But for most patients, “gadolinium retention has not been directly linked to adverse health effects,” the FDA stressed in an agency news release. It also said “the benefit of all approved GBCAs continues to outweigh any potential risks.”
For now, the FDA says gadolinium agents have only one known health risk: A “small subgroup” of kidney failure patients has developed a rare skin condition that causes a painful thickening of the skin.
But gadolinium can linger in the body “for months or years after receiving the drug,” the agency said, noting more research is warranted. It is asking manufacturers of GBCAs to “also conduct human and animal studies to further assess the safety of these contrast agents.”
This is not the agency’s first warning on gadolinium. In September, an FDA panel called for a warning to be added to the agents’ labels. The warning specifies that trace amounts of gadolinium may be retained in various organs, including the skin, bone and brain.
The big question remains, though: What, if any, are the harms?
Doctors have used gadolinium-based agents for 30 years — totaling more than 300 million doses, said Dr. Vikas Gulani. He’s an associate professor of radiology at Case Western Reserve University in Cleveland.
But, Gulani explained, researchers have only recently discovered that trace amounts of the metal can be left behind in the brain.
One study on the issue was presented Nov. 29 at the annual meeting of the Radiological Society of North America.
It involved nearly 4,300 older adults and found no evidence that gadolinium exposure was related to faster mental decline over several years, according to a team led by Dr. Robert McDonald, of the Mayo Clinic in Rochester, Minn.
“This study provides useful data that at the reasonable doses 95 percent of the population is likely to receive in their lifetime, there is no evidence at this point that gadolinium retention in the brain is associated with adverse clinical outcomes,” McDonald said in a news release from the meeting.
So, “at this point,” Gulani said, “we are not aware of any harms from these agents being retained in the brain.”
Still, he added, the latest study does not rule out that possibility. There are open questions — including whether gadolinium exposure could be related to other neurological issues, such as movement problems.
Also, any theoretical risks from the agents have to be balanced against their proven benefit in improving MRI image quality.
However, there are cases where an MRI can be done without a contrast agent, Gulani said. “It’s reasonable for patients to ask their doctor whether it’s needed or not,” he added.
Gulani helped craft the latest recommendations from the International Society of Magnetic Resonance in Medicine on using MRI contrast agents. They say that if a gadolinium-based agent is not necessary, it should be skipped.
“It’s just like with any other medication,” Gulani said. “If you don’t need it, don’t use it.”
More information
The U.S. Food and Drug Administration has more on gadolinium-based contrast agents.

MONDAY, Dec. 18, 2017 (HealthDay News) — They may be touted as relatively harmless, but rubber and plastic bullets can cause serious injury and death, and should not be used when riots occur, researchers say.
These types of bullets — widely used by police, military and security forces to disperse crowds — are meant to incapacitate people by causing pain or injury.
But a team from the University of California, Berkeley, said the speed at which many rubber or plastic bullets leave the weapon is the same as live ammunition.
In fact, the new study suggests “that these weapons have the potential to cause severe injuries and death,” said researchers led by Dr. Rohini Haar, of UC Berkeley’s School of Public Health.
They looked at data from 26 published studies examining outcomes among nearly 2,000 people, mostly young adults, who suffered injuries after being hit by rubber or plastic bullets in numerous countries — Israel/Palestine, Britain/Northern Ireland, South Asian countries, the United States, Switzerland and Turkey.
In total, 53 (3 percent) of the people died of their injuries, Haar’s team reported Dec. 18 in the journal BMJ Open.
“Penetrative injuries” accounted for 56 percent of the deaths, and blunt trauma for 23 percent of the deaths, the research group said.
Disability after being hit by a rubber or plastic bullet wasn’t rare, either: About 300 (16 percent) of survivors suffered permanent disability. Blindness and removal of the spleen or a section of the bowel due to abdominal injuries accounted for most of this disability, the study found.
In fact, of the more than 2,100 injuries reported, 71 percent were judged to be severe, with injuries to the skin, hands and feet most common.
Several of the studies also found that rubber or plastic bullets are highly inaccurate and can miss the target — injuring peaceful demonstrators and bystanders instead.
The bottom line, Haar and her colleagues said, is that rubber and plastic bullets “do not appear to be an appropriate means of force in crowd-control settings,” and international guidelines on the use of crowd-control weapons are required to halt further needless injury and death.
More information
Find out more about traumatic injuries at the University of Florida.

FRIDAY, Dec. 15, 2017 (HealthDay News) — The skin disorder rosacea should be added to the list of chronic diseases linked to obesity, researchers report.
Their large new study found that the risk for rosacea increases among women as weight rises.
The researchers reviewed the records of nearly 90,000 U.S. women, tracked over 14 years. They found a 48 percent higher likelihood of rosacea among those with a body mass index (BMI) greater than 35 than among women of normal weight.
A BMI of 30 or higher is considered obese. For example, a 5-foot-5-inch woman weighing 180 pounds has a BMI of 30. At the same height, someone who weighs 211 pounds has a BMI of 35.
“Particularly considering the chronic, low-grade inflammatory state associated with obesity, and also the [blood vessel] changes caused by obesity, it is not surprising obesity may increase the risk of rosacea,” said study author Wen-Qing Li. He’s an assistant professor of dermatology and epidemiology at Brown University in Providence, R.I.
“Our study holds general public health significance, [adding] rosacea to the list of chronic diseases associated with obesity,” Li said. “A healthier weight should definitely be encouraged for general health and well-being.”
Rosacea is characterized by facial redness and flushing, bumps and pimples, skin thickening and eye irritation, according to the National Rosacea Society. It’s estimated to affect 16 million Americans.
The condition typically develops after age 30. Symptoms can wax and wane, varying by patient. There’s no cure for rosacea, which is managed with oral and topical medications, antibiotics and laser treatments, among other therapies.
Li and his team identified more than 5,200 cases of rosacea among tens of thousands of participants in the national Nurses’ Health Study. They were tracked from 1991 to 2005. Not only was the risk of rosacea markedly higher among those with BMIs above 35, but there was a trend toward higher risk for rosacea among those who had gained weight after age 18.
What’s more, the likelihood of developing rosacea increased by 4 percent for every 10-pound weight gain in study participants. The researchers also noted significantly higher odds of rosacea as girth — waist and hip measurements — rose.
Li said the findings may prompt dermatologists to advise their patients with rosacea to reach a normal weight to “relieve their disease,” though further clinical evidence is still needed.
About a third of U.S. adults are classified as obese. Obesity has been linked to an increased risk for many health problems, including diabetes, cancer and early death, as well as inflammatory skin conditions such as psoriasis and acne.
Li also noted that his research didn’t delve into the various subtypes of rosacea, which can be triggered by different factors. Also, the study only found an association between obesity and rosacea, rather than a cause-and-effect link.
“It is warranted to examine the effect of obesity on each type separately,” Li said. “A large-scale clinical study would also be required to confirm that losing weight helps the relief of rosacea severity.”
Dr. Ross Levy, chief of dermatology at Northern Westchester Hospital in Mount Kisco, N.Y., said he wasn’t surprised by the study’s findings. He agreed with Li that obesity-driven inflammation could account for the increased risk for rosacea with weight gain.
“I would never tell somebody that if you lose weight your rosacea will get better, but I would probably hint to them that it might,” said Levy, who wasn’t involved in the new study. “Obesity is probably the No. 1 killer in the U.S. No one thinks of it that way, but it has such a great impact on everything.”
The study was published in the December issue of the Journal of the American Academy of Dermatology.
More information
The National Rosacea Society has answers to common questions about rosacea.

FRIDAY, Dec. 15, 2017 (HealthDay News) — A new drug that targets a genetic flaw common to most cancer cells is showing potency against many tumor types.
The preliminary trial of a drug called ulixertinib was conducted with 135 patients who had already failed treatments for one of a variety of advanced, solid tumors.
Researchers led by Dr. Ryan Sullivan, of Massachusetts General Hospital, said ulixertinib did seem to spur at least a “partial response” to the therapy or “disease stabilization,” regardless of cancer type.
“It was exciting to see responses in some patients,” said Sullivan, an oncologist and member of the Termeer Center for Targeted Therapies at the Boston hospital.
“The results of this study can be built upon to develop better treatment regimens for these patients,” he said in a news release from the American Association for Cancer Research (AACR).
One cancer specialist explained how ulixertinib works on the cellular level.
“It inhibits the MAPK/ERK pathway, which is a chain of proteins in the cell that communicates a signal from a receptor on the surface of the cell to the DNA in the nucleus of the cell,” said Dr. Maria Nieto.
“When one of the proteins in the pathway is mutated, it can become stuck in the ‘on’ or ‘off’ position, which is a necessary step in the development of many cancers,” said Nieto, a medical oncologist at Northwell Health’s Huntington Hospital in Huntington, N.Y.
Ulixertinib effectively inhibits this broken cellular pathway, and that inhibition “can be therapeutically exploited in multiple different cancers such as melanoma, lung, colon, and low-grade ovarian cancer,” she explained.
Sullivan said that because ulixertinib targets the “final regulator” in the MAPK/ERK pathway, it might avoid cancer cells’ typical resistance to drug treatment.
“A great number of cancers — including melanoma and lung cancers — have mutations in the MAPK/ERK pathway, and while current therapies target proteins in this cascade, many patients develop resistance to current drugs,” he explained.
“The common denominator in these failed therapies is that the cancer has found a way to activate ERK. Therefore, the development of ERK inhibitors is a crucial next step to target this aberrant pathway,” Sullivan said.
When it came to side effects, ulixertinib appeared to have a “tolerable” profile, with most issues not particularly severe, the researchers said. But this was still a small phase 1 trial, Sullivan noted, so larger trials are needed.
The study was funded by the drug’s developer, Biomed Valley Discoveries, and published Dec. 15 in the AACR journal Cancer Discovery.
Dr. Stephanie Bernik is chief of surgical oncology at Lenox Hill Hospital in New York City. She agreed that the new medicine has great potential.
“Ulixertinib halts the message at the last stop before the signal can make it into the nucleus and creates a second roadblock, therefore halting growth of the cancer cell,” Bernik explained. “This kind of therapy shows great promise and allows drugs to work synergistically, making it much harder for the cancer cell to figure out a way to continue to multiply and spread.”
According to the study team, the U.S. Food and Drug Administration has fast-tracked ulixertinib for development and potential approval.
More information
There’s more on cancer cells at the U.S. National Cancer Institute.

WEDNESDAY, Dec. 13, 2017 (HealthDay News) — Exposure to firefighting chemicals may be one reason why Florida firefighters have a higher-than-normal rate of skin cancer, a new study suggests.
The researchers analyzed data from almost 2,400 firefighters statewide who’d participated in a cancer survey. They found that 4.5 percent — 109 firefighters — had been diagnosed with skin cancer. That included 17 cases of melanoma, 84 cases of other types of skin cancer and 18 of an unknown type of skin cancer.
The melanoma rate among the firefighters was 0.7 percent, compared with 0.011 percent in the general population, according to the researchers.
“We believe there are chemicals in the work environment that, when firefighters come into contact with them, might be increasing the risk for specific kinds of cancer,” study leader Dr. Alberto Caban-Martinez, said in a University of Miami news release. He’s with the university’s Sylvester Comprehensive Cancer Center.
The study noted that other factors also could be involved, such as:
Increased ultraviolet radiation exposure when firefighters respond to an emergency during daylight hours
Improper decontamination of safety gear after an emergency call
Exposure to diesel exhaust from fire trucks engines idling while firefighters prepared to respond to a call
A major surprise in the study was the younger ages that skin cancer occurred among the firefighters, Caban-Martinez said.
The firefighters’ average age when diagnosed with skin cancer was 42 for melanoma, 38 for non-melanoma and 42 for unknown skin cancer types.
The findings were published online Dec. 13 in the journal JAMA Dermatology.
“If a primary care physician has a patient who is a firefighter, the findings suggest that they make it a point to do a full body skin exam and provide health education on skin cancer protection,” Caban-Martinez said.
He noted that some firefighters may not consider skin cancer screenings until they’re older, but this study suggests it’s wise to begin full body skin examinations at an earlier age.
“Firefighters are already at risk for developing and dying from other cancers, so it’s not surprising to me that our research has now identified that the risk of skin cancer among firefighters is elevated, particularly within the South Florida context,” said senior study author Erin Kobetz, associate director of the Sylvester Center.
“There are certain occupational-vulnerable groups, including firefighters, who may need more regular skin cancer screening or to start earlier,” Kobetz added.
More information
The U.S. National Cancer Institute has more on skin cancer.

WEDNESDAY, Dec. 13, 2017 (HealthDay News) — You don’t have to be famous for your public health message to reach millions.
A new case study describes how Tawny Dzierzek, a young nurse from Kentucky, posted a startling selfie on social media in April 2015, shortly after she had a skin cancer treatment.
Dzierzek was a regular user of tanning beds in her youth. She was diagnosed with skin cancer at age 21. By the time she was 27, she’d had basal cell skin cancer five times, and squamous cell skin cancer once.
Her selfie was shared 50,000 times on social media in less than a month, and her story received widespread media attention. Google searches about skin cancer climbed to near-record levels when news coverage about Dzierzek’s selfie was at its peak, according to the case study published Dec. 13 in the journal Preventive Medicine.
Online searches about skin cancer and tanning were as much as 489 percent higher than normal, and searches about skin cancer prevention rose by as much as 232 percent, the researchers found.
“A growing body of research shows that [personal] stories can be very impactful — more impactful than [educational] information — in delivering a health message,” said study author Seth Noar. He’s a professor at the University of North Carolina’s School of Media and Journalism.
“This event was really a perfect storm of a compelling story and graphic selfie, which seems to have led this Facebook post to go viral,” Noar added in a university news release.
If public health researchers and groups identified such events when they occur, they could ramp up messages about medical issues and reach many more people, the study authors suggested.
“When this happened, it really captured the public’s attention on social media and through national media coverage,” Noar said. “That’s an opportune time for all of us to get the message out about the dangers of tanning beds.”
Ultraviolet radiation from the sun and tanning beds is categorized as a known carcinogen by the World Health Organization. Tanning beds cause as many as 400,000 cases of skin cancer each year in the United States, according to the American Academy of Dermatology.
“Tanning bed use has been starting to decline, and events like this may play a role by reaching people through a 21st century medium with a real story that strikes a chord at a very human level,” Noar said.
More information
The U.S. National Cancer Institute has more on skin cancer.

WEDNESDAY, Dec. 13, 2017 (HealthDay News) — Many of the foods most associated with holiday meals can actually be good for you and, because they’re filling, leave you feeling satisfied with small servings.
Skinless white turkey meat tops the list. A 3-ounce slice has 26 grams of protein, less than 1 gram of saturated fat and just 130 calories.
Skip the gravy, but enjoy some homemade cranberry sauce, which typically has 27 calories per tablespoon. Use whole berries, fresh or frozen, and cut the amount of sugar in standard recipes in half. Add zero-calorie stevia if it needs more sweetening once it has chilled.
Sweet potatoes pack a punch of vitamins, minerals and antioxidants for just 113 calories per half-cup. Slow roasting brings out their natural sweetness, so no need for sugar, butter or marshmallows. Add a dash of cinnamon and nutmeg instead.
Pumpkin and other winter squashes are also great side dishes when roasted, and have just 50 calories per cup. Puree cooked pumpkin, add spices, and you have a pudding-style dessert.
One medium apple has about 90 calories. To make another sweet treat, bake apples (with the skin on for the most fiber), again using only spices to enhance the natural flavor. Besides cinnamon, try ground ginger or allspice for a taste change-of-pace. If you want to add crunch, sprinkle with a tablespoon of your favorite nuts.
Always keep traditional fruits and vegetables low-calorie and savor their natural flavors by using simple cooking methods like roasting, baking and steaming. Remember that ingredients like butter, cream and sugar are the real diet downfalls.
More information
Harvard Health has more on the healthy benefits of turkey and how it compares to other holiday main dishes.

FRIDAY, Dec. 8, 2017 (HealthDay News) — If you or a family member develops scabies, you need to take immediate action, a dermatologist advises.
Scabies is a common skin condition caused by the human itch mite. Symptoms include an itchy rash, sores and a thick crust on the skin.
“Most people get scabies from direct skin-to-skin contact, although it’s possible to get scabies from infested bedding, clothes and furniture,” said Dr. Joshua Zeichner, an assistant professor of dermatology at the Icahn School of Medicine at Mount Sinai in New York City.
“Since scabies is contagious, it tends to spread easily among children, mothers with young children and residents of nursing homes and extended care facilities,” he explained in an American Academy of Dermatology news release.
If you suspect you or someone in your family has scabies, see a doctor. Medicine to treat scabies is only available with a prescription.
Because scabies is highly contagious, it’s also important to notify people around you. If you get treatment, people you live with or have close contact with also need treatment. Otherwise, they can get the mites, and you can get them again, Zeichner said.
The day that you begin treatment, wash all bedding, clothes and towels in hot water and dry everything in a hot dryer. If you can’t wash something in a washing machine, take it to a dry cleaner or seal it in a plastic bag for at least one week to kill the mites, which can’t survive longer than three to four days without being on a human.
It’s also important to vacuum your entire home on the day you start treatment. After you’re done, throw away the vacuum bag or wash the vacuum canister with hot, soapy water.
You don’t need to treat your pets because the human itch mite cannot survive on animals, Zeichner said.
More information
The U.S. Centers for Disease Control and Prevention has more on scabies.

THURSDAY, Dec. 7, 2017 (HealthDay News) — Bathing in water is just as effective for the treatment of eczema as bathing in a bleach solution, a new review of previous research indicates.
Doctors sometimes recommend a bleach bath, which is a mixture of a small amount of bleach in a pool of cool or warm water. But investigators say the finding should encourage people with eczema to bathe regularly with just water, without fear of drying out their skin. It should also help people avoid the stinging and burning that can come with a bleach bath.
“I don’t know if it throws the baby out with the bathwater, but bleach baths lack the evidence to support how commonly they are being recommended,” said senior author Dr. Jonathan Silverberg. “The water baths appear to be doing most of the heavy lifting. If bleach is adding any benefit, it’s quite modest.”
Silverberg is an assistant professor of dermatology at Northwestern University’s Feinberg School of Medicine in Chicago and director of its Multidisciplinary Eczema Center.
Bathing with a bleach solution is sometimes prescribed as a means of controlling both bacterial infection and symptoms, the researchers noted. But their review, which analyzed data from four earlier studies, suggests that it’s no more effective at either task than simply bathing in water.
In addition, because many people with eczema also struggle with asthma, bleach fumes can also trigger asthma attacks.
“Patients with eczema have much higher rates of asthma than non-eczema patients,” Silverberg said in a Northwestern news release.
“Everyone’s home setting is going to be different, and many bathrooms don’t have great ventilation, so a warm bath that causes the bleach to fume can be the perfect setup to potentially have an asthma flare-up,” he said.
The findings are outlined in a recent issue of Annals of Allergy, Asthma and Immunology.
More information
The U.S. National Institute of Allergy and Infectious Diseases has more on eczema.

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